3. HEMS
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Motorcycle and Road Trauma
A man, 30 y.old, is on motorcycle and is crashed by a vehicle on the
major road NH48 .
The patient is consciousness, the head protected with a helmet,
and has a lot of pain of all the left body.
The traffic jam is stopped and the patient can’t move and is
keeping on the ground.
People call the emergency number and the HEMS is on alert
5. HEMS
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Motorcycle and Road Trauma
Interpretation
• Road Trauma on major road
• High velocity
• Motorcycle
• Biker consciousness and head protected with Helmet
• How many patients? One patient or more because there is
one car? People ejected of the car? Other patient
unconsciousness?
• Biker = Pain located on the left body: Left shoulder? Left
thorax? Left abdomen? Left pelvic and left ankle?
• Active and Significant haemorrhage that needed point of
compression? The people around the scene can do something
to control the haemorrhage?
6. HEMS
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Motorcycle and Road Trauma
Medical Answer – Question 1
• Main road with high velocity accident (Vittel
criteria)
• Maybe haemorrhage shock
• Motorcycle: no protection like airbag
• Probably patient with polytrauma
• Quick response medical treatment for the golden
hour priority
• HEMS is the good choice to be quickly with the
patient and to be quickly in the trauma center.
7. HEMS
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Motorcycle and Road Trauma
The choice of HEMS is doing to treat and
transport this patient. Witch material do you
need inside ?
Question 2
8. HEMS
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Motorcycle and Road Trauma
Medical Answer – Question 2
• Emergency bag with drugs and the material of intubation
• Monitor for haemodynamic control with possibility for a cardiac
defibrillation
• Oxygen bottle (full)
• Respiratory monitor system
• Catheter and Intra bones system (Ei-ZO)
• Fluid resuscitation equipment
• Blood and plasma if possible
• Mucositis pump
• Thoracic/ chest tube
• Sonography if possible
• Cervical spine and belt immobilization
• Material of small surgery , tourniquet, haemostatic dressing
• Material again hypothermia
9. HEMS
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Motorcycle and Road Trauma
First Exam…
The medical team come with HEMS by 10 minutes of
flight. The patient is on the ground, without the
helmet. He is oriented and speaking with you. The first
exam: HR 130 bpm, RR 30 SpO2 90% AA, AP 70/40
symmetric. With the auscultation : less noise on the
left lung- With the palpation : abdominal pain with
defense, the pelvic is fixed, no neurological and motor
deficit on the two legs , no deformation of the left leg.
There is no blood on the ground.
11. HEMS
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Motorcycle and Road Trauma
Medical Answer – Question 3
Use the ATLS process(Advanced Trauma Life Support) Y/N
§ A= patient is speaking. No problem with Airway
§ B= difficulty to breathe, polypnea RR 30, asymmetric
auscultation (left ↓↓)
§ C= HR 130 tachycardia and collapses with hypotension,
§ The six sites of bleeding to consider are: scalp and external,
chest, abdomen, long bones, pelvis and retroperitoneal
(SCALPeR)
§ D= Consciousness, oriented, testing of neurological deficit.
§ E= Hypothermia
13. HEMS
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Motorcycle and Road Trauma
Medical Answer – Question 4 (golden hour…)
1. Immobilization for the rachis: rigid cervical spine immobilization Y/N – 10’’
2. Oxygen therapy with a mask: the objective SpO2> 95% Y/N – 5’’
3. Fluid resuscitation Y/N
§ 2 IV line or If it is not possible use the intra bones system (ex : EiZO
system) max 5’
§ use a pressure bag to facilitate the perfusion 5’’
§ 500ml fluid Resuscitation with isotonic fluid < 20 min
§ If necessary, use amine drug like norepinephrin 3’
4. Severe haemorrhage shock
§ Tranexamic acid 1g IV (Exacyl®) Y/N 1’
§ Transfusion of Blood and/or plasma immediately possible Y/N
§ Pelvic belt Y/N 1’
5. FAST (Focused Assessment with Sonography for Trauma) Y/N 1,5’
14. HEMS
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Motorcycle and Road Trauma
FAST Focused Assessment with Sonography for Trauma
Right Left
Normal Lung Pneumothorax
30 sec
15. 18/12/2019 15
Motorcycle and Road Trauma
FAST Focused Assessment with Sonography for Trauma
Liver
R Kidney
L Kidney
Spleen
30 sec
16. 18/12/2019 16
Motorcycle and Road Trauma
FAST Focused Assessment with Sonography for Trauma
Heart
LIver
R Kidney
pericardium
30 sec
17. 18/12/2019 17
Motorcycle and Road Trauma
FAST Focused Assessment with Sonography for Trauma 1 min 30 sec
• SpO2 (O2 15L/Min) 96%
• BP 95/70mmHg MBP 65mmHg
• 15 min fly to trauma center
• Left pneumothorax , 2 strategies
1. Thoracic tube + auto transfusion before to fly
2. Simple monitoring & Fly
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Motorcycle and Road Trauma
FAST Focused Assessment with Sonography for Trauma 1 min 30 sec
• Intra abdominal haemorrhage
• Alert dispatch & trauma center+++
21. HEMS
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Motorcycle and Road Trauma
Medical Answer – Question 5
§ We go to the trauma center
§ Risk for the pneumothorax
§ Be careful to the altitude
§ Risk of emergency landing
22. HEMS
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Motorcycle and Road Trauma
During the fly, question 6…
During the flight, the patient has acute
difficulties to breath, the SpO2 is 85% even
the oxygen 15L/min, the HR is 140 BPM,
and the Systolic pressure is 70 mmHg. The
left thorax seems to have no movement.
You can access to the anterior thorax face…
What do you do ?
23. HEMS
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Motorcycle and Road Trauma
During the fly, medical answer 6…
• FAST ? --- > compressive left hemopneumothorax
• Emergency decompression 2 ICS
• Alert trauma center
§ to prepare blood
§ to prepare cell saver tool
§ to alert the surgeon team (thoracotomy)
• Fluid resuscitation & norepinephrin
24. HEMS
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Motorcycle and Road Trauma
Conclusion…
• 15 min on the field :
1. Immobilization for the rachis: rigid cervical spine immobilization10’’
2. Oxygen therapy with a mask: the objective SpO2> 95% Y/N 5’’
3. Fluid resuscitation max 5-8’
4. Severe haemorrhage shock max 2’
§ Tranexamic acid 1g IV (Exacyl®) Y/N 1’
§ Pelvic belt Y/N 1’
5. FAST (Focused Assessment with Sonography for Trauma) Y/N 1,5’
• 15 min of fly with emergency decompression
• Anticipation +++
• Alert dispatch & trauma center (trauma system)
25. 18/12/2019
Doctor Hervé Roy
Emergency Physician
Doctor Pascal Zellner
Emergency Physician
Mr. Ralph Setz
HEMS Marketing
Director
Doctor Nicolas Peschanski
Emergency Physician
THANK YOU FOR YOUR ATTENTION
